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- Cortez, Daniel, et al.
(författare)
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Vectorcardiography identifies patients with electrocardiographically concealed long QT syndrome
- 2017
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Ingår i: Heart Rhythm. - : Elsevier BV. - 1547-5271. ; 14:6, s. 894-899
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Tidskriftsartikel (refereegranskat)abstract
- Background Long QT syndrome (LQTS) and genotypic subtypes are associated with distinctive T-wave patterns, arrhythmogenic triggers, and corrected QT (QTc) interval risk associations. Twenty percent of patients with LQTS have normal QTc values, defined as electrographically concealed LQTS (ecLQTS). Vectorcardiography (VCG) has value for sudden cardiac death risk assessment. Objective The purpose of this study was to determine the use of VCG to identify patients with ecLQTS. Methods We performed a retrospective analysis in patients with ecLQTS with resting QTc values <440 ms. Computerized derivation of the spatial mean and peak QRS-T angles, QTpeak, Tpeak-Tend (angle between QRS and T-wave peak amplitudes in 3-dimensional space), and T-wave eigenvalues (TwEVs; amplitudes [in microvolts] for each of the first 4 TwEVs were derived from the 12-lead electrocardiogram) was performed. The results were compared with those for healthy controls. Intergenotype differences were analyzed. Results Of 610 patients with LQTS, 169 patients (28%) had ecLQTS (86 (51%) men; mean age 22 ± 16 years; mean QTc interval 422 ± 14 ms). There were 519 healthy controls (44% men; mean age 19.8 ± 13.8 years) with a mean QTc interval of 426 ± 28 ms. Among VCG parameters, QTpeak and TwEVs significantly differentiated patients with ecLQTS from controls (P ≤.01 for each) as well as differentiated KCNQ1-encoded type 1 LQTS (ecLQT1), KCNH2-encoded type 2 LQTS (ecLQT2), and SCN5A-encoded type 3 LQTS (ecLQT3) from controls (P <.01). ecLQT3 was differentiated from controls and ecLQT1 and ecLQT2 by the fourth TwEV (P <.01 for each). The fourth TwEV differentiated symptomatic patients with ecLQTS from asymptomatic patients with ecLQTS (P <.01). Conclusion ecLQTS can be distinguished from controls using QTpeak. ecLQT3 was best differentiated by the fourth TwEV. VCG may facilitate familial diagnostic anticipation of LQTS status before the completion of mutation-specific genetic testing even with normal resting QTc values.
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- Hill, JA, et al.
(författare)
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Medical misinformation: Vet the message!
- 2019
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Ingår i: Heart rhythm. - : Elsevier BV. - 1556-3871 .- 1547-5271. ; 16:3, s. 332-333
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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- Johnson, Linda S.B., et al.
(författare)
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Irregularity and lack of p waves in short tachycardia episodes predict atrial fibrillation and ischemic stroke
- 2018
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Ingår i: Heart Rhythm. - : Elsevier BV. - 1547-5271. ; 15:6, s. 805-811
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Tidskriftsartikel (refereegranskat)abstract
- Background: Atrial fibrillation (AF) is defined as an irregular supraventricular tachycardia (SVT) without p waves, with duration >30 seconds. Whether AF characteristics during short SVT episodes predict AF and stroke is not known. Objective: The purpose of this study was to determine whether irregularity and lack of p waves, alone or in combination, during short SVT episodes increase the risk of incident AF and ischemic stroke. Methods: The population-based Malmö Diet and Cancer study includes 24-hour ECG screening of 377 AF-free individuals (mean age 64.5 years; 43% men) who were prospectively followed for >13 years. There were 65 AF events and 25 ischemic stroke events during follow-up. Subjects with an SVT episode ≥5 beats were identified, and the longest SVT episode was assessed for irregularity and lack of p waves. The association between SVT classification and AF and stroke was assessed using multivariable adjusted Cox regression. Results: The incidence of AF increased with increasing abnormality of the SVTs. The risk-factor adjusted hazard ratio for AF was 4.95 (95% confidence interval 2.06–11.9; P <.0001) for those with short irregular SVTs (<70 beats) without p waves. The incidence of ischemic stroke was highest in the group with regular SVT episodes without p waves (hazard ratio 14.2; 95% confidence interval 3.76–57.6; P <.0001, adjusted for age and sex). Conclusion: Characteristics of short SVT episodes detected at 24-hour ECG screening are associated with incident AF and ischemic stroke. Short irregular SVTs without p waves likely represent early stages of AF or atrial myopathy. Twenty-four–hour ECG could identify subjects suitable for primary prevention efforts.
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